Dr Michael Lim, a senior consultant at the Paediatric Pulmonary and Sleep Division, National University Hospital, Singapore, speaks to Roshini Claire Anthony on the rare disease that is cystic fibrosis.

Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.

The risk factors and outcomes associated with an increased risk of permanent pacing include atrial fibrillation (AF) ablation, multivalve surgery and New York Heart Association (NYHA) functional class III/IV, a recent study has found.

Defining trends and patterns of cardiovascular risk in Asia: The LIFECARE study

30 Nov 2018

Despite risk factors for cardiovascular disease (CVD) being similar around the world, the burden of CVD is not uniform across nations. Furthermore, CVD-related death in low- to middle-income countries (LMICs) has increased by two-thirds in the last 30 years, and now account for a whopping 80% of global deaths due to CVD.

Despite this, major global studies on the epidemiology of cardiovascular(CV) risk factors have included only small numbers of Asian participants,and studies closer to home have left important questions unanswered.In particular, it is still not clear how exposure to risk factors can impact on CV health in Asian populations, why ischaemic heart disease and stroke are the leading causes of premature CV death in Southeast Asia, and the impact of psychosocial issues on CVD.

“Major global studies on the epidemiology of cardiovascular risk factors have included only small numbers of Asian participants and studies closer to home have left important questions unanswered.”

The LIFE course study in CARdiovascular disease Epidemiology (LIFECARE) is filling this knowledge gap. Just over 10,000 adults from Indonesia, Malaysia, the Philippines and Thailand are being studied to explore the epidemiology of CVD in Southeast Asia, along with their health-related quality of life (HRQoL) and healthcare utilization. They will be followed up in 3–5-year cycles, with the first cycle now complete, and the next round expected to start in 2020.An overview of the study has been published in the International Journal of Epidemiology. Detailed interviews using standardized questionnaires administered in local languages have been used to collect information on sociodemographic characteristics and CV risk factors among participants with a median age of 40 years,who are mostly married, employed and have a university education.These data vary between countries and some differences compared with national averages have been identified.Interestingly, only 20% of the overall study population reported being smokers. These data have already led to 12 publications in peer-reviewed scientific journals,including validation of the translated study questionnaire across countries,with more publications planned.

What has LIFECARE revealed so far?

Of note, data from the Philippines show that CVD is the largest contributor to mortality, and that CV risk factors are more common in wealthier men living in cities, in contrast to developed nations where CVD has a stronger link with poverty. Metabolic syndrome is also more prevalent in wealthier city dwellers in the Philippines, which is in sharp contrast to the inverse relationship between metabolic syndrome and socioeconomic status described in developed countries.

In Indonesia, metabolic syndrome is prevalent amongst young adults aged <39 years, with more than half of this group being obese. A greater prevalence of type 2 diabetes has also been observed among participants with a lower education level, and was found to be one of the underlying conditions with the strongest links to poor mental health in the Thai group.The ongoing, prospective nature of this study, including the collection and storage of biological samples for future investigations, means that CVD trends that develop over time will be identified, and the relevance of as yet undiscovered biomarkers may be retrospectively assessed. The data set is also being made available to independent researchers upon request.

Summary

The longitudinal LIFECARE CVD cohort study is generating a comprehensive data set on the prevalence of CVD and modifiable risk factors in four under-studied Southeast Asian countries. Following completion of the first round of follow-up, a number of hypotheses have been tested and the results published in peer-reviewed scientific journals, with more publications and studies expected to follow as new hypotheses are tested and further data are generated.

Dr Michael Lim, a senior consultant at the Paediatric Pulmonary and Sleep Division, National University Hospital, Singapore, speaks to Roshini Claire Anthony on the rare disease that is cystic fibrosis.

Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.

The risk factors and outcomes associated with an increased risk of permanent pacing include atrial fibrillation (AF) ablation, multivalve surgery and New York Heart Association (NYHA) functional class III/IV, a recent study has found.